Clinical Presentation, Etiology, Management Strategies and Outcomes of Non-Traumatic Ileal Perforation in a Tertiary Care Center: An Ambi-spective Observational Study

Background: Nontraumatic perforation of the ileum is still a difficult surgical emergency, which remains an important issue in regions where infectious diseases and chronic inflammatory conditions are prevalent. Moreover, patients commonly seek medical attention when symptoms have advanced with little time for delay. Untimely diagnosis or operative intervention may result in rapid deterioration of the clinical course and increased morbidity and mortality. It is important to gain a better insight into the way in which these patients present together with the conditions leading to preperforation and the intraoperative findings. These insights can help in the early detection and better decision-making of management. Objective: The aim of this study was to outline the clinical features, etiological factors, surgical approaches and postoperative outcomes in individuals treated for non-traumatic ileal perforation at a tertiary care centre. Methods: This ambispective observational study was conducted in the Department of General Surgery of a tertiary teaching hospital and included 157 patients in whom non-traumatic perforation of the ileum was confirmed during surgery. The cohort comprised both retrospectively identified cases and prospectively recruited participants. Information was collected on demographic characteristics, symptom duration, findings on clinical examination, laboratory results, imaging features, operative details, procedure undertaken, postoperative course and histopathological reports. All collected data were entered into a statistical database and analysed using SPSS software. Continuous variables were summarised using means with standard deviations or medians with interquartile ranges, based on distribution. Comparative analyses were performed to explore associations between factors such as time to hospital presentation, underlying aetiology, severity of peritoneal contamination and postoperative complications or death. Chi-square or Fisher’s exact tests were used for categorical variables, while independent t-tests or Mann-Whitney U tests were applied for continuous variables. Statistical significance was set at p < 0.05. Results: All patients had acute abdominal pain with either localized or widespread tenderness and several had pneumoperitoneum on imaging. There was significant variance in the time between the beginning of symptoms and operation and longer delays were substantially linked to more problems. The majority of patients had one or more ileal perforations with fecal or purulent contamination. While resection with anastomosis or stoma formation was reserved for gangrene, multiple perforations, cancer or tuberculous disease, primary closure was the most common technique. The most common postoperative complications were enterocutaneous fistula, surgical site infection and anastomotic leak. The most frequent causes were found to be cancer and typhoid illness. Higher complication rates were observed in patients with late presentation, severe contamination and malignant or tuberculous pathology. Mortality was linked to older age, septic shock and significant delays in operative management. Conclusion: The diagnosis and treatment of non-traumatic ileal perforation remain extremely difficult. Improving survival still requires prompt detection, vigorous resuscitation and early surgical surgery. While primary closure is adequate for straightforward perforations, complex etiologies often demand resection-based procedures. Routine histopathological assessment is crucial for defining the underlying cause and directing further management.